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Obesity paradox and stroke: a narrative review

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Abstract

Background

Despite obesity is an established risk factor for stroke, several studies reported a better outcome after stroke in obese and overweight patients. This counterintuitive finding, which was described in the whole spectrum of cardiovascular diseases, is known as obesity paradox.

Objective

This is a narrative overview on the obesity paradox and stroke.

Methods

We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library from inception to 2019, and selected papers that discussed the association of obesity with outcome and mortality after stroke.

Results

The majority of studies reported lower mortality rates and better functional outcome after stroke in obese and overweight patients compared with normal weight and underweight patients, suggesting the existence of an obesity paradox in stroke. However, available studies are limited by several major methodological concerns including absence of randomized trials, retrospective nature of most studies, assessment of obesity with body mass index (BMI), non-linear relationship between BMI and outcome, short follow-up period, and differences in co-morbid conditions and stroke characteristics.

Conclusions

The existence of an obesity paradox in stroke is still controversial and further higher quality evidence is needed to clarify the relationship between obesity and stroke outcome.

Level of evidence

Level V, narrative review.

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Authors and Affiliations

  1. Neurology Unit, IRCCS “Sacro Cuore-Don Calabria” Hospital, Via don A. Sempreboni, 5, 37024, Negrar, Verona, Italy

    Stefano Forlivesi

  2. Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Manuel Cappellari & Bruno Bonetti

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  1. Stefano Forlivesi
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  2. Manuel Cappellari
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Correspondence to Stefano Forlivesi.

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Forlivesi, S., Cappellari, M. & Bonetti, B. Obesity paradox and stroke: a narrative review. Eat Weight Disord 26, 417–423 (2021). https://doi.org/10.1007/s40519-020-00876-w

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